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Next Generation Digital Natives

Posted on December 19, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I saw the tweet and picture above and couldn’t help but laugh. My children do stuff like this all the time and I love it. Of course, my children aren’t talking about being paged (they don’t work in healthcare), but they definitely know all about technology. In fact, at a recent parent teacher conference, my 7 year old’s teacher talked about how well she did on the computer and how she could navigate any of the technology with ease. Yep, I was a really proud parent at that moment.

Why share this on an EMR blog? Well, a part of me has my head in the cloud (pun intended) as I’m considering the various gifts I’m giving my children this year. My wife and I are all about the technology, but also technology that helps them use their creativity. Lest you worry, we also have incorporated plenty of balls and other things they can use outside. However, I think this shift is an important sign of what’s to come.

Think about how different the EHR world would be if all of healthcare were digital natives that just understood how technology worked. I recently was asked by an older friend (ironically he’s an ortho doc) to help him and his wife get the Apple TV working in their home. I’d never used it before, but I’d used something kind of similar. At one point I asked her if she knew how to do something with it (she didn’t know), and then I proceeded to just figure out how it worked.

The reality is that I didn’t know the Apple TV interface at all, but I did know intuitively how things like that were designed. Some of that comes from experience with so many different software packages. Some of that comes from having done some programming. The next generation healthcare IT user is going to have this literally built into who they are. Look at the hour of code initiative if you want to see why I think everyone is going to have at least some programming experience.

Every EHR trainer is reading this and imagining how different their EHR training classes would have gone if those attending were all digital natives. That’s far from the reality today and so we have to do things differently, but it will be what we find in the future.

Burned In EHR Workflows

Posted on November 7, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

One of the hospital CIOs at The Breakaway Group focus group at the CHIME Fall Forum talked about what he called “Burned IN EHR Workflows.” I thought the concept was really interesting and no doubt something we can all relate with. We all know when the workflows we do are finally burned into our psyche. We often call it our daily routine and we all hate when our routine is disrupted.

As I thought about this idea, I wondered at what point the EHR workflow is finally “burnt in.” There are a lot of factors that go into burning in the EHR workflow. I’d say it rarely happens during EHR training. Although, with the right EHR training it could be the case. The key question is how well your EHR training emulates the actually environment and workflow of the user. Are you just training them on the EHR software or are you training them on the EHR workflow with the new EHR software? I always did the later and found it so much more effective.

As another CIO at CHIME said, “Users don’t want to know the 10 ways to do the same thing. They want to know the single most effective way to do it.” Of course, figuring out the most effective way to do something is the hard part and why so many EHR trainings fall short.

The good thing about burnt in EHR workflows is that if you’ve implemented a great workflow, then it’s great. The problem is that we often burn in sub optimal EHR workflows. I had this happen to me all the time. I’d ask one of my EHR users why they did something a certain way when it would be so much easier to do it another way. It was just the way the EHR workflow was burnt in.

Changing that already burned in EHR workflow is really hard. Although, it’s not impossible and is often necessary. You just have to burn in a new workflow. However, it also often requires an explanation of why the new workflow is better. Good luck changing someone’s workflow when they liked the old workflow. You better have a good reason or they’re unlikely to change.

This Image Says it All – Paperless EHR Training

Posted on May 8, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I love irony and so I loved this picture and message posted to Instagram by @Liz_Money. She said:

“The irony of teaching a paperless EMR. I have a massive binder of paper. And this is just the first draft of curricula that will have endless edits and reprints. #paperguilt”

Paperless EHR Training

For those keeping track at home, I think this is Epic, but it could be Cerner since she does some work on both.

All I can say is…we can do better!

Training New EHR Users

Posted on March 14, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Todd Stansfield has a really great guest blog post over on EMR and HIPAA where he writes about “Learning by Doing.” While this principle applies to a lot of parts of life, I agree with Todd that it’s absolutely valuable when doing EHR training.

I was particularly intrigued by the process that Todd and The Breakaway Group use to train on EHR. I know they have a bunch of researchers at The Breakaway Group that have worked hard to understand the right way to train. However, what struck me is that I found exactly the same thing in my experience training users on EHR.

When I was working my full time job managing, implementing, upgrading, etc the EHR, I was also assigned to train any new staff that got hired by our clinic. Because of our clinic’s relationship with the local medical school and some general staff turnover, I got quite good at training new users on the EHR.

My process was really simple. I would first train the users on the workflow through the EHR. Then, to reinforce what I taught, I would have them go through the same workflow (ie. learning by doing). After I’d shown them what to do, they usually had to stumble through what I’d just taught them. However, once they stumbled through the second time and actually did it themselves, I can’t remember them ever asking me how to do it again. It was really quite amazing to watch. The questions I would get later were more about why, how, or advanced functionality.

Trust me, this is not an easy thing to do. When I was in the second phase of EHR training where I let them do it directly on the EHR, I had to really control my urge to just show them the solution. Sometimes I would literally stand up and walk away from the computer to prevent myself from just showing them how to do it. It’s almost irresistible to step in and do it. However, I had to resist that urge and let them fail and explore a little bit for them to really understand how it worked.

Of course, there’s a point where you might need to step in, because they just flat out don’t remember. That’s fine, but then that often means they’ll need to do that same step again so they don’t forget.

I saw first hand the concept of learning by doing. It’s a powerful one and more EHR vendors should employ it in their EHR training.

Cutting Down On EMR Implementation Struggles

Posted on August 14, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

In blogs like this one, we spend a lot of time talking about the frustrations doctors face when adapting to use of an EMR. But what if there were ways EMR implementations could be less painful for doctors (and their staff)? According to Dike Drummond, MD, there’s three major ways to minimize the pain and improve the process of putting an EMR in place in a medical practice.

* Change your attitude

According to Drummond, doctors often start out hating EMR technology and resisting the idea it could ever be helpful. “We treat the computer and the programs as if they rose from the very fires of hell to torment us,” Drummond notes. As a result, physicians fail to embrace the technology and never learn how to use it well, leading to more unhappiness, he suggests.

Instead of being angry and frustrated, set yourself a goal of becoming a power user, Drummond advises his colleagues. Take all vendor training twice, and have your nurse and receptionist do so too; customize your EMR to offer the most personalized and elegant experience possible, including automating any repeat keystrokes; and sit and watch over the shoulder of well-versed colleagues to see what existing power users do. “Just one tip from a power user colleague can make a huge difference in each patient encounter,” he says.

* Don’t force paper and EMR to compete

Too often, medical practices overlay new documentation requirements for their EMR on top of their paper chart patient flow process, and results are usually pretty ugly, Drummond warns. Doing so “sets up a Death Match between your old flow systems and your new EHR,” he says.

The better strategy is find ways to integrate the two processes, he  suggests. It’s much better to find ways to alter the way you see patients so the EMR documentation gets built into your patient flow.  Refusing to accept this makes no sense, he argues.

Leverage your team

Doctors are used to being the one who steps out in front and leads the team, but in this case, it’s important for doctors to dig in and take advantage of the insights their team can offer.  Doctors should get everyone’s ideas on how to refine workflow through powerful brainstorming sessions.

To further the process, Drummond recommends doctors ask open-ended questions such as the following:

~  What do you see me doing that I can stop – or  you can do better?
~  What ideas do you have on how we can do things differently to make documentation easier?
~  How can we share the charting activities more effectively?

Drummond’s points are well-taken, but I’d go even further. Doctors don’t need to just adapt to an EMR and tailor it to their needs, they have to embrace digital tools — from smartphones and tablets to patient portals and e-mail — if they’re going to survive the next wave of medical practice.  But for starters, it certainly makes sense to stop hating on EMRs and learn how to make them work as a supportive tool. The advent of EMRs is inevitable, so why fight?

California Nurses Slam Sutter’s Epic System

Posted on July 17, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Nurses at two Sutter hospitals have flooded the management with complaints that the Epic EMR installed there is causing safety problems and eating up time best spent in patient care.

According to a statement from the California Nurses Association, more than 100 RNs at Alta Bates Summit Medical Center facilities in Oakland and Berkeley have filed reports citing problems with the new Epic system in place there.  The nurses submitted these complaints on union forms designed to document assignments the nurses believe to be unsafe.

Specific incidents documented by the nurses included the following. (Apologies for the length of the list, but it’s worth seeing.)

• A patient who had to be transferred to the intensive care unit due to delays in care caused by the computer.
• A nurse who was not able to obtain needed blood for an emergent medical emergency.
• Insulin orders set erroneously by the software.
• Missed orders for lab tests for newborn babies and an inability for RNs to spend time teaching new mothers how to properly breast feed babies before patient discharge.
• Lab tests not done in a timely manner.
• Frequent short staffing caused by time RNs have to spend with the computers.
• Orders incorrectly entered by physicians requiring the RNs to track down the physician before tests can be done or medication ordered.
• Discrepancies between the Epic computers and the computers that dispense medications causing errors with medication labels and delays in administering medications.
• Patient information, including vital signs, missing in the computer software.
• An inability to accurately chart specific patient needs or conditions because of pre-determined responses by the computer software.
• Multiple problems with RN fatigue because of time required by the computers and an inability to take rest breaks as a result.
• Inadequate RN training and orientation.

This is not the first time nurses have gone on the warpath over issues with their hospital’s EMR rollout. Just last month, RNs at Affinity Medical Center in Massillon, OH got national attention when they cited problems in training and safety with the Cerner rollout in progress there.

Taken on their own, I don’t think such protests are going to much to slow the progress of EMR rollouts nationwide, even if the nurses involved are spot on in their observations.  Once the EMR juggernaut starts rolling, it’s very, very hard to slow it down.

But with any luck, the complaints will draw the eyes of regulators and patients to EMR safety and training concerns, and that will lead to some form of change. The issues raised by the Sutter RNs and others shouldn’t (and can’t) be pushed aside indefinitely.

Balancing EHR Change vs Train

Posted on May 21, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I was talking with Heather Haugen from The Breakaway Group (A Xerox company) today and in our discussion she used the word “train”, but I heard the word “change”. I always love a good play on words and so it was interesting for me to consider the difference between change and train in an EHR implementation.

Every EHR implementation I’ve been apart of walks a fine line between users wanting the EHR software to change versus the need for an EHR user to change. One of the most common phrases out of a doctor’s mouth during an EHR implementation is, “Why did the EHR vendor implement that feature like this? Did they not talk to a doctor? This makes no sense.” We’ve dug in previously to the concept of EHR vendors consulting doctors during their EHR development so we won’t go into that further now. Every EHR vendor consults doctors, but no two doctors practice alike. So, it’s normal that every doctor would wonder why certain features are implemented the way they are implemented.

When faced with this issue, the doctor is faced with an important decision with two options. The first option is to work with the EHR vendor and convince them to change how their EHR works. In a large hospital EHR vendor situation, this can be almost impossible. Plus, even if that EHR vendor does like your suggested change it’s going to take months and sometimes years before that change is implemented in the EHR software, tested, and released all the way to you the end user. Yes, these changes can go faster with a SaaS EHR, but it still will likely take months before the change reaches the end user.

In some cases, you can wait for the change to be made before using that EHR feature. However, more often than not a doctor is going to have to train on how the EHR vendor has implemented the feature. This highlights to me why having great EHR training is so important. Sure, many of the things in an EHR will be intuitive, but great EHR training is still always beneficial. EHR software is too complex to just pickup and use. Plus, even if you can use the basic EHR features, good training points out the ways to optimize the EHR workflow.

Most doctors don’t understand why various parts of an EHR workflow can’t be easily changed. They just think change should happen easily. Ironically, the doctor then proceeds to resist any change to how they want to work.

What Really Differentiates EHR Companies?

Posted on February 8, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

My post yesterday on EMR and HIPAA called “Does Spending More on EHR Mean You Get More?” started me thinking what does differentiate one EHR company from another. I think there’s a real disconnect between what most people selecting an EHR use to differentiate EHR companies with what really matters to the users of an EHR.

First let’s take a look at some of the many ways that I see doctors and hospital CIO’s using to differentiate EHR companies. Many use price as an indicator of quality. Hopefully this post puts that to bed. Price matters, but it’s not a great indicator of EHR success. Many are swayed by great sales and marketing by EHR companies. It’s hard to deny that seeing an EHR vendor with a full HIMSS booth doesn’t have some effect on what you think of that EHR vendor. Going along with this is having the big, well branded name recognition. Although, what’s in a name if the EHR software doesn’t meet your specific needs?

Another differentiator that many use is KLAS or other ratings. When I’ve dug into all of the various EHR rating and ranking systems, there are flaws in all of them. Some lack enough data to really draw conclusions. Some use bias methods for collecting data. Some EHR ranking services don’t use data at all. It’s amazing how interested we get in a list that may or may not have any legitimate value. Every EHR vendor has some flashy numbers to share with you. Just remember that numbers can lie. You can make them appear any way you want.

I’m a little torn on the idea of EHR certification and access to EHR incentive money being a point of differentiation for EHR vendors. There are so few that can’t get you there, that it’s almost a non-issue. Sure, if you really want to get the EHR incentive money, you could and should talk to the users of that EHR that have gotten the EHR incentive money. However, because almost every EHR vendor is a certified EHR that can get you to meaningful use, not being certified might actually be a more exciting. The story is reasonable: our EHR focused on what doctors care about in an EHR as opposed to some random government requirements. Could be a compelling message. Especially for those doctors who don’t qualify for the EHR incentive money.

What should be used to differentiate EHR companies?

The number one thing that I think doctors should look for in an EHR is efficiency. A large part of the coming Physician EHR revolt is due EHR software’s impact on physician efficiency. Yet, most doctors selecting an EHR pay little attention to the effect of an EHR on efficiency. This data is harder to get, but a good survey of existing EHR users can usually get you some good information in this regard.

Another area of differentiation with EHR companies should be around their EHR support and training. How quickly an EHR vendor answers support requests and how well an EHR gets you up and running on an EHR is extremely important. As someone on LinkedIn mentioned today, EHR is not plug-n-play software. There’s more to an EHR implementation than just plugging it in and going. It requires some configuration and learning in order to use an EHR in the most effective way.

How come we don’t use the quality of care that an EHR provides as a method of differentiating EHRs? The answer is probably because it’s a really hard thing to measure. I wonder if any EHR has found a way to show that their EHR provides better care. There’s plenty of anecdotal examples, but I wonder if anyone has more data on this.

Another point of differentiation that I think matters is how an EHR company approaches its relationship with the users. Does the doctor, practice and hospital feel like a partner of the EHR company or are they a distant customer. You can imagine which situation is better than the other. This relationship will matter deeply as you run into problems that are unique to your environment. I assure you that this problems will come.

I also see technology approach as a really important factor for EHR companies. When I say this, I think most people start to think about SaaS EHR vs Client Server EHR. Certainly that is one major component to this idea, but it should go much deeper. You can tell by the way an EHR’s technology approach if they’re focused on the right things. Do they take shortcuts when they implement technology? Are they thoughtful about what really matters to the EHR user? Do they implement something on a whim or do they think deeply about the impact of a feature? While every EHR company has limits on what they can put out in a release, they can still provide a great roadmap of the current release and their plans for future releases which shows that they understand the needs of the users.

I’m sure there are many more good ways to differentiate an EHR company. I look forward to hearing more of them in the comments. We just need to expand the discussion to things that really matter as opposed to basing our EHR decisions on vanity metrics.

Cutting EMR Training Budget Can Create Serious Problems

Posted on April 17, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Not long ago, American Medical News ran an article on training up medical practice staffers for EMR use. The piece concluded that while practices may save some bucks on the front end, they generally end up regretting it later.  An anecdote from the piece:

Nine months after All Island Gastroenterology and Liver Associates in Malverne, N.Y., went live with its electronic medical record system, practice administrator Michaela Faella realized things had not gone as smoothly as planned.

Even though the staff had used other health information technology systems for many years and considered itself tech-savvy, it had taken everyone six months to learn how to use the new EMR system. Several months later, the staff still had not become proficient at it.

The problem was not with the staff, but that the practice cut training short to save time and money. “Training was not placed high on the priority list, and we paid the price for it,” Faella said.

As the piece notes, many practices assume that the training bundled into the cost of their new EMR will meet their needs, and find out to their regret that this isn’t the case.  (In fact, I’d argue that this is more the rule than the exception, based on anecdotes I hear in the field and in conversations with physicians.)

A consultant quoted in the piece suggests that practices should consider three main issues when planning for training:

1) How much data they’ll be dealing with, which can vary greatly depending on whether all data is imported in advance or done patient by patient

2) Whether the practice will be integrating new systems into the EMR, such as e-prescribing, or conversely, adding an EMR to existing systems

3) Whether using the EMR will call for using new hardware such as tablet computers

Personally, I’m not satisfied by that list at all.

What about, first and foremost, assessing the staff’s existing skills more precisely, walking staffers through the various layers of the EMR on a daily basis, forming teams of superusers within the organization to help the less skilled and taking steps to be sure EMR problems don’t interrupt critical functions (a backup/workaround plan for the short term)?

What do you think?  Does the list above cover the critical EMR practice integration issues?  Am I just being testy?

101 Tips to Make Your EMR and EHR More Useful – EHR Tips 1-5

Posted on January 24, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Time for the next entry covering Shawn Riley’s list of 101 Tips to Make your EMR and EHR More Useful. I can’t believe that this is the last post in the series. I think it’s been a good series chalk full of good tips for those looking at implementing an EHR in their office. I’d love to hear what people thought and if they’d like me to do more series like this one. Now for the final 5 EMR tips.

5. Automatic trending helps all over the place – A picture is worth a thousand words and this is never more true than when we’re talking about trending. Make sure your EHR software can quickly take a set of results and/or data points and graph them over time.

4. Keep training over and over – Are you ever done learning software? The answer for those using an EMR is no. Part of this has to do with the vast volume of options that are available in EMR software. However, the training doesn’t necessarily have to come from formal training sessions. Much of the training can also come by facilitating interaction and discussion about how your users use the software. By talking to each other, they can often learn from their peers better ways to use the software.

3. Infrastructure is key to performance – I love when people say “My EMR is Slow” cause it’s such a general statement that could have so many possible meanings. Regardless of the cause of slowness, the EMR is going to get the blame. For those wanting to dig in to the EMR slowness issue, you can read my pretty comprehensive post about causes of EMR slowness. I think you’ll also enjoy some of the responses to that EMR slowness post.

Infrastructure really matters when someone is using an EMR all day every day. There’s no better way to kill someone’s desire to use an EMR than to have it be slow (regardless of who’s responsible).

2. Quit pulling charts as soon as possible – I think this tip should be done with some caution. In certain specialties the past chart history matters much more than in others. Although, it’s worth carefully considering how often you really look through the past paper chart in a visit. You might be surprised how rare it is that you really need the past paper chart. If that’s the case, consider only pulling the chart when it’s needed. If you only find yourself looking through the past paper chart for 2 or 3 key items, then just have someone get those 2 or 3 items put into the EMR ahead of time. Then, it will save you having to switch back and forth. Plus, then it’s there for the next time the patient visits.

1. Crap process + Technology = Fast Crap – Perfect way to end 101 EMR and EHR Tips! I like to describe technology as the great magnifier. The challenge is that it will magnify both the good and bad elements of your processes. Fix the process before you apply the technology.

If you want to see my analysis of the other 101 EMR and EHR tips, you can find them all at the following link: 101 EMR and EHR tips analysis.